Swearing: Impact on Nurses and Implications for Therapeutic Practice Teresa Elizabeth Stone RN, RPN, BA, MHM A thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy University of Newcastle January 2009 Teresa Elizabeth Stone 1 Declaration I hereby certify that the work embodied in this thesis is the result of original research and has not been submitted for a higher degree to any other University or Institution. Signed: ……………………………………………………. Date: ………………………………………………… Teresa Elizabeth Stone Teresa Elizabeth Stone 2 Dedication This thesis is dedicated to my Mother and Pa who have given me a lifetime of love and support. Teresa Elizabeth Stone 3 Acknowledgments My list of dramatis personae for this study is long. My principal supervisor, Mike Hazelton, remained unfailingly encouraging and optimistic and his wealth of experience in research was invaluable. He told me he had been caught laughing to himself while reading through the questionnaire, a cameo of him that I treasure. Ed Clayton and Kim Colyas worked wonders with my statistics, and I painfully and slowly learned much and forgot more. Margaret McMillan came in slightly later in the piece, was completely inspirational, and really got me over the line. Jill Valdar is the editor and friend every girl needs, despite language that made her hair curl. Associate Professor Brian Taylor was a wonderful resource for all things linguistic and he gave freely of his own time. Heartfelt thanks to my wonderful husband Scott, who is forever supportive, and to Claudia, my dog, who has patiently accompanied me, snoring, as I wrote. Thanks, too, to the many nurses who participated in the study. Teresa Elizabeth Stone 4 “As the matter stands, [this] poor devil of an author is proposing an expedition into regions that, despite many hundreds of years of literary enterprise, are still remote and untravelled. It were not surprising therefore at the onset that the readers should inquire if [s]he is sincere and reliable, or whether on the contrary [s]he is counterfeiting honesty with a sanctimonious face. It were perhaps right they should be assured that the trip is really intended for their welfare, and that the skipper is not given to risk the safety of [her] craft for a mere capful of wind.” (Sharman, 1884, p.11). Teresa Elizabeth Stone 5 2.13 Developmental aspects .....................................................................49 2.14 Conclusion .........................................................................................51 Chapter 3 ....................................................................................................52 S WEARING AND P SYCHOPATHOLOGY ........................................52 3.1 Introduction ...........................................................................................52 3.2 Normal and abnormal swearing ...........................................................52 3.3 Swearing associated with mental health disorder ...............................53 3.4 The psychoanalytic perspective ...........................................................54 3.5 The neurophysiological perspective ....................................................55 3.6 Swearing, mood and psychosis ...........................................................55 3.7 Swearing and its relation to verbal aggression ....................................56 3.8 The association between swearing, verbal aggression, and physical aggression ..................................................................................................57 3.9 Measurement of verbal and physical aggression ................................61 3.10 Management of aggressive behaviour in inpatient settings ..............62 3.11 Conclusion .........................................................................................66 Chapter 4 ....................................................................................................67 T HE I MPACT OF S WEARING ON N URSES .................................67 4.1 Introduction ...........................................................................................67 4.2 Verbal aggression and nurses: the incidence .....................................67 4.3 Effects of swearing and verbal aggression on nurses .........................69 4.4 Offendedness .......................................................................................70 4.5 Explanatory style ..................................................................................71 4.6 Locus of control ....................................................................................72 4.7 The use of swearing by nurses ............................................................73 4.8 Swearing within the context of a therapeutic relationship ...................73 4.9 Swearing within a work or leisure context. ..........................................74 4.10 Therapeutic alliance ...........................................................................77 4.11 Conclusion .........................................................................................78 Chapter 5 ....................................................................................................79 C ONTEXT OF PRACTICE: V ERBAL AND P HYSICAL A GGRESSION IN I NPATIENT F ACILITIES ..................................79 5.1 Introduction ...........................................................................................79 5.2 Aims and hypotheses ...........................................................................81 Teresa Elizabeth Stone 7 5.3 Method .................................................................................................83 5.3.1 Setting ........................................................................................ 83 5.3.2 Respondents .............................................................................. 83 5.3.3 Procedure ................................................................................... 84 5.3.4 Materials ..................................................................................... 84 5.4 Results .................................................................................................87 5.4.1 Descriptive statistics ................................................................... 87 5.4.2 Change over time in verbal or physical aggression .................... 90 5.4.3 Differences between genders in verbal and physical aggression ........................................................................................... 94 5.4.4 Association between the severity of verbal and of physical aggression ........................................................................................... 96 5.4.5 Association between verbal and physical aggression against others and mental health disorders ..................................................... 96 5.4.6 Nurses’ explanations for patient aggression ............................... 99 5.4.7 The association between diagnosis and perceived motivation for aggression .................................................................................... 106 5.4.8 Interventions following an episode of verbal or physical aggression ......................................................................................... 108 5.4.9 Interventions following an episode of verbal aggression .......... 108 5.4.10 The association between diagnosis and intervention ............. 110 5.4.11 The relative frequency of perceived internal or external motivation for aggression and intervention ........................................ 114 5.4.12 Perceptions about whether aggression is preventable ........... 114 5.4.13 Nature of swearing ................................................................. 116 5.4.14 Impact on nurses .................................................................... 117 5.5 Discussion ......................................................................................... 118 5.6 Limitations ......................................................................................... 123 5.7 Conclusion ......................................................................................... 124 Chapter 6 ................................................................................................. 126 T HE Q UESTIONNAIRE S TUDY ..................................................... 126 6.1 Introduction ........................................................................................ 126 6.2 Aims and hypotheses ........................................................................ 128 6.3 Methods ............................................................................................. 129 6.3.1 Setting ...................................................................................... 130 6.3.2 Respondents ............................................................................ 130 Teresa Elizabeth Stone 8 6.3.3 Procedure ................................................................................. 130 6.3.4 Materials ................................................................................... 131 6.3.5 The pilot study .......................................................................... 135 6.3.6 The main study ......................................................................... 135 6.3.7 Ethical considerations ............................................................... 136 6.3.8 Data analysis ............................................................................ 137 6.4 Results